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Peanut Allergy and Tree Nut Allergy – the Facts

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Peanut Allergy and Tree Nut Allergy – the Facts Peanut Allergy and Tree Nut Allergy – The Facts Peanut allergy and tree nut allergy can sometimes result in severe allergic reactions and understandably this can cause intense anxiety among those affected and their families. This Factsheet aims to answer some of the questions which you and your family might have about living with peanut allergy or tree nut allergy. Our aim is to help you to minimise risks and learn how to treat an allergic reaction should it occur. The peanut is a legume, related botanically to foods such as peas, beans and lentils. Tree nuts are in a different botanical category and include almonds, hazelnuts, walnuts, cashew nuts, pecans, Brazil nuts, pistachios and macadamia nuts. A key message for people with peanut or tree nut allergy is take your allergy seriously. You should visit your GP and ask to be referred to an NHS allergy clinic for a proper assessment and high-quality advice. Throughout the text you will see brief medical references given in brackets. If you would like the full references, please call the Anaphylaxis Campaign helpline on 01252 542029. How common are peanut allergy and tree nut allergy? Research has shown that peanut allergy among children increased significantly during the 1990s. In 2002 a medical team on the Isle of Wight found that around one in 70 children across the UK was allergic to peanuts, compared with one in 200 a decade before (Grundy et al, 2002). A more recent follow-up study by the same group suggests a slight fall in cases (Venter et al 2010). The high rates of peanut allergy were acknowledged in a UK Government report in 2004, which put the figure among children in England at around 250,000 (House of Commons 2004). Similar trends for peanut allergy have been noted in the USA (Sicherer et al, 2010). A 2011 paper shows that tree nut allergy is more common in older age groups than among children (Venter and Arshad 2011). What are the symptoms that could occur? The symptoms of a food allergy can come on rapidly. These may include nettle rash (otherwise known as hives or urticaria) anywhere on the body, or a tingling or itchy feeling in the mouth. More serious symptoms may include: • Swelling in the throat and/or mouth • Difficulty breathing • Severe asthma • Colicky abdominal pain Document Reference: ACFS21 Published: June 2018 Review date: June 2021 ©Anaphylaxis Campaign 2020 The term for this more serious form of allergy is anaphylaxis. In extreme cases there could be a dramatic fall in blood pressure (anaphylactic shock). The person may become weak and floppy and may have a sense of something terrible happening. This may lead to collapse and unconsciousness. Death from anaphylaxis can occur, although thankfully this is rare. A 2013 study concluded that fatal anaphylaxis among people with food allergy was rarer than other causes of accidental death in the general population (Umasunthar et al, 2013). In our view, people with food allergy can reduce the risks considerably if they are properly diagnosed, take special care when food is around, and carry prescribed medication everywhere. How can I get a diagnosis? If you suspect or know you have peanut allergy or tree nut allergy you need to go to your GP and seek a referral to an NHS allergy clinic for a thorough assessment, which will include tests to confirm which types of nut are responsible for causing your symptoms. A referral is important even if your symptoms were mild because it is possible that a future allergic reaction could be more severe. Although your GP or specialist may find it hard to predict the severity of future symptoms, your medical background may provide clues. According to experts (Muraro et al 2007) you are at high risk if: • You have had a severe reaction in the past, such as swelling in the throat, breathing difficulties (even mild) or faintness • You have asthma as well as allergy, particularly if that asthma requires regular preventer treatment • You have had an allergic reaction to a tiny amount of peanut or tree nut The age of the person with the allergy could also be a risk factor. Fatal reactions are very rare, but where they do happen, they are more likely to occur between the ages of 17-27 (Pumphrey, 2004). As young people begin to manage their allergies for themselves, they may be less cautious with regard to risk, reluctant to ask direct questions in restaurants and subject to peer pressure. To find your nearest allergy clinic visit the website of the British Society for Allergy and Clinical Immunology www.bsaci.org How is an allergic reaction treated? If peanut allergy or tree nut allergy is confirmed, you may be prescribed an adrenaline auto-injector for self-use in an emergency. If you are prescribed adrenaline, it should be kept with you at all times – with no exceptions. After an injection has been given, someone must dial 999 immediately as symptoms may return after a short period and more than one injection may be required. The emergency service operator must be told the person is suffering from anaphylaxis (pronounced ana-fill-axis). If you are prescribed an adrenaline auto-injector, you will need to know how and when to use it. Correct usage of an injector will significantly reduce the risk of an allergic reaction progressing. Ask your GP or allergist for advice. You can also find help on the website relevant to the injector you carry. There is evidence that many people have found it difficult to use the injectors currently available (Umasunthar et al, 2015). Therefore regular training in their use is essential. Document Reference: ACFS21 Published: June 2018 Review date: June 2021 ©Anaphylaxis Campaign 2020 These are the injectors currently prescribed in the UK: Emerade: www.emerade.co.uk EpiPen: www.epipen.co.uk Jext: www.jext.co.uk. A link to our separate Factsheet on adrenaline can be found towards the bottom of this Factsheet. This addresses questions such as ‘How many injectors should I carry?’ and ‘How is adrenaline administered?’ How do I reduce risks? Shopping: Always read food labels, even if you are buying a product you have eaten many times before as recipes and manufacturing methods sometimes change. Check both the inner and outer wrapping of multipacks. All pre-packaged food sold in the UK must declare and highlight the presence in the ingredient list of 14 major allergens even if they appear in small quantities. These 14 allergens include peanuts and common tree nuts (almonds, hazelnuts, walnuts, cashew nuts, pecan nuts, Brazil nuts, pistachio nuts, macadamia nuts and Queensland nuts). “May contain” warnings (sometimes known as advisory labelling) are used by food companies where there is a risk of cross-contamination during the production process. Advisory labelling is widespread and causes immense frustration to shoppers, but we believe these warnings should be heeded at all times and never ignored. Sometimes there are genuine risks. You may eat a product many times without a problem, but cross- contamination may have occurred the next time you eat it. Eating out: Under UK law, food businesses selling catered or loose food are required to provide information about the presence of any of the 14 major allergens, including peanuts and tree nuts. This information can be provided in writing and/or orally. If information is provided orally, the food business must ensure there is written signage that is clearly visible to indicate that allergen information is available from a member of staff. Systems should also be in place to ensure that, if requested, the information given orally is supported in a recorded form (in writing for example) to ensure consistency and accuracy. You should question staff very directly, asking whether the nut you are allergic to is an ingredient of the food you have chosen or whether there is a risk of cross-contamination. Don’t be afraid to ask the waiter to check with the chef. Food tips 1. Watch out for satay sauce (made with peanuts), pesto sauce (which can contain tree nuts or pine nuts) and marzipan and praline (confectionery products made with nuts). Salad dressings may contain nut oils. Document Reference: ACFS21 Published: June 2018 Review date: June 2021 ©Anaphylaxis Campaign 2020 2. Curries and other Eastern dishes are high risk because many of them contain peanuts or tree nuts and their presence may not be obvious if the food is spicy. Studies focusing on takeaway meals have shown that even when nut-free meals were ordered, a significant proportion still contained nuts (Leitch and Walker 2005). 3. Foods likely to contain peanuts or tree nuts include the following: Cakes, biscuits, pastries, cereal bars, confectionery, ice cream, desserts, vegetarian products, salads and salad dressings. This list is not exhaustive. 4. Watch out for peanut shoots as they are being sold in some UK shops. They can be used in stir-fry dishes and salads and could be mistaken for bean sprouts. Always read food labels carefully. 5. Roasting and heat treatment do not reduce the allergenicity (capacity to produce an allergic reaction) of peanuts or tree nuts. In fact, laboratory experiments have suggested that roasting and heating peanuts (but not boiling) may actually increase their allergenicity (Maleki et al 2000). 6. Be careful when others share food with you. For example, a member of the Anaphylaxis Campaign reports that her son suffered a severe allergic reaction after drinking from a classmate’s bottle. The classmate had eaten peanuts. Which other foods should I avoid? A significant proportion of people with peanut allergy are also allergic to tree nuts or will become allergic to them.
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